Laparoscopic-assisted low anterior resection of the rectum--a review of the fascial composition in the pelvic space.

INTRODUCTION: Outcomes of rectal cancer treatment depend on the operative technique, and complication rates vary. Complications can occur during mobilization of the rectum, with damage to the ureter, autonomic nerves, and the rectum itself. Frequencies of these complications can be reduced by careful dissection of the correct tissue plane in the pelvic space.
METHODOLOGY: This paper reviews the fascial composition of the rectum for low anterior resection of the rectum. To date, fascial composition of the pelvic space has been considered based on clinical anatomy and histological examination of cadaveric specimens. However, clarification of fascial composition is clearly limited, to a certain extent, in histological examinations compared with clinical anatomy.
CONCLUSIONS: First, some degree of dissociation must exist between the histological examination and clinical anatomy. Second, surgeons should not consider fascia encountered intraoperatively as an artifact. To address these difficult issues, consideration should be made purely from the perspective of clinical anatomy. Originally, the trunk was embryologically regarded as a multi-layered structure (like an onion). Understanding the fascial composition of the abdomen is comparatively easy when approached from this perspective. If this theory is adapted to the pelvic space in order to avoid antilogy, an understanding of the fascial composition of the pelvic space should also be possible. We review previous papers based on this theory.